Provider Demographics
NPI:1851597611
Name:SUNNY ISLES EYE CENTER INC
Entity Type:Organization
Organization Name:SUNNY ISLES EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIS
Authorized Official - Prefix:DR
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGUDAEV
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:305-917-1037
Mailing Address - Street 1:17100 COLLINS AVE
Mailing Address - Street 2:#112
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3675
Mailing Address - Country:US
Mailing Address - Phone:305-917-1037
Mailing Address - Fax:305-917-1337
Practice Address - Street 1:17100 COLLINS AVE
Practice Address - Street 2:#112
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3675
Practice Address - Country:US
Practice Address - Phone:305-917-1037
Practice Address - Fax:305-917-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620825801Medicaid
FL620825801Medicaid